Thursday Thoughts: Agonist/Antagonist Treatment Part 2 | Modern Manual Therapy Blog

Thursday Thoughts: Agonist/Antagonist Treatment Part 2


Last week I had a poll on a painful/limited cervical case and pain and limited SLR. It asked whether or not you would treat the painful side/opposite side/both for cervical and hip flexors/extensors/both with the SLR. That poll can be found here.

The results of the poll are above. The majority would treat both ipsilateral hip flexors and extensors, followed by hip extensors, then hip flexors. For the cerviccal patient, most would treat the left side, followed by both sides, then in distant third right side.

Despite me now having more time than ever to treat patients (30-60 min of 1:1), I find myself treating less and less areas, but larger portions of the same area. I want you to try some of the same things that experience has taught me to cut down on your potentially overtreating a patient.

For the cervical patient, with left cervical pain and limited retraction/SB to the left. I would start treating the left side and in a majority of the cases, I would not need to treat the right side at all. I used to treat both sides with the thinking of freeing up the downglide on the involved side and upglide on the uninvolved side. It worked.

Then I got busier in the clinic, and found myself trying only to treat the involved side, that also worked, treatments were faster, motion was restored, and the patient could perform their own self resets for HEP. They were less sore (or not at all now) due to not only using much less force, but also prevention of overstimulation of an already sensitized nervous system.

Look at it this way, if a different patient had limited and painful left shoulder motion, would you treat the right shoulder if it was not painful and had full strength and motion? I believe in most cases, it is the same for the cervical spine, if the cortical representation of the neck is only smudged for the left side of the neck, does the right side need novel inputs to help reduce threat of movement?

In the limited SLR case, I choose to treat the agonist over the antagonist for the reason of novel input only. Most likely, this patient has been "stretching" their hamstrings, and possible been to other clinicians who have tried various hamstring techniques. Even the belief that their hamstrings are "tight" or "I have never been able to touch my toes" may be self limiting. Treating the hip flexors to promote folding/contraction is a novel strategy and also assists with active SLR, thus also helping inhibition of the hip extensors.

If their is one thing I have learned over the years, is that for treatments, many times you get more results with less effort. Try it, test, and re-test, and let me know what happens.

Keeping it Eclectic....


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